Prevalence of Narcissism

How common is Narcissism in the United States? Based on news reports that stretch from Politics to Hollywood, is it increasing?

Estimates suggest 0.5 to 1.0 percent of the general population meet the criteria for Narcissistic Personality Disorder in the United States. It has been identified in 6.0 percent of the forensic population, 20 percent of the military population, and 17 percent of first-year medical students. About 2.0 to 16.0 percent of those seeking help from a mental health professional will receive a narcissistic personality disorder diagnosis. There is some sense that Personality disorders may be increasing. However, whether that is due to more sophisticated diagnosis abilities, a reflection of current culture and mass social media, or actual increases is as yet of unknown.

Malignant Narcissism

I have heard the term “malignant narcissism”, but I don’t really understand what it means. Can you explain it?

Malignant narcissism is an extreme form of a Narcissistic personality disorder or NPD. According to the dictionary, "malignant" is an adjective with synonyms such as hostile, spiteful, malevolent, malicious, infectious, uncontrollable, and injurious. Words that have been used to describe malignant narcissistic characteristics include: vicious, cruel, and spiteful; anticipates betrayal and seeks punishment for it; ruthless, calculating, and callous; brutal, inhumane, and merciless; jealous, hateful, remorseless; callous, fearless, aggressive, and endlessly revengeful. This involves deliberate attempts to cause harm, suffering, or distress; feeling or showing ill will or hatred; dangerous or harmful in influence or effect. When narcissism becomes malignant, revenge may be exhibited as a life-long retaliation with a determination to discredit and destroy. This type of narcissism can quite easily morph into or become co-morbid with an Antisocial personality disorder. When thwarted in desires or goals, there is a potential for homicidal or suicidal behaviors, perhaps to gain notoriety and sympathy. Malignant narcissism is dangerous.

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Treatment for NPD & APD

Narcissism: There is no known cure for Narcissistic personality disorder. Treatment and therapy can help people manage their moods, change their disruptive behaviors, and treat comorbid problems such as anxiety disorders and depressive disorders. Success is dependent upon whether the individual is willing to acknowledge his or her problems and work with a therapist. Psychotherapy is the first line of treatment. Medications may be prescribed to manage some of the symptoms.

Antisocial: There is no known cure for Antisocial personality disorder, and it is difficult to treat. Because this disorder tends to have social, legal, and financial implications, multiple treatment options must be considered. Treatment and therapy may help individuals manage their moods, change disruptive behaviors, and treat comorbid problems, such as anxiety and depression. Because of the risk of manipulative behaviors, therapists need to use caution, being fair, and setting limits.

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Antisocial Personality Disorder (APD)

This mental illness involves erratic or dramatic behavior and extremely impulsive, theatrical, illegal, and promiscuous actions. It is characterized by an enduring behavior that exhibits a disregard for, and violation of, the rights of others. There appears to be some heritability along with other neurobiological, developmental, and social determinants. Males are up to five times more likely to receive this diagnosis and are responsible for almost 50% of serious criminal behavior. They evidence a disregard for the rights or needs of others, tend to break the law, engage in substance abuse, using others for their own benefit, and typically lack a sense of moral conscience. When they lie, steal, fight, or get angry, they exhibit no remorse for their actions and behaviors. Without empathy, they act indifferent to the outcomes of their hurtful actions, blaming others and rationalizing the reasons for harming or deceiving them. Their impulsive, irritable, inconsistent, and aggressive or dangerous behaviors may lead to frequent job or relationship changes. The non-clinical terms of sociopath or psychopath may be used to describe some characteristics linked with this disorder.

Narcissistic Personality Disorder (NPD)

Twin studies have indicated a moderate to high heritability for NPD, along with possible neurobiological factors. These individuals can be charming and charismatic, love-bombing individuals who they believe can benefit them. Exhibited behaviors include an aggressive self-enhanced and self-preoccupied aggrandizement, over-controlling, insensitive, critical, and provocative. They believe themselves more important than anyone else. They exaggerate their achievements and expect to be recognized as superior, feel entitled to special treatment, continual admiration and obedience, and exploit others to achieve personal gain. They are intensely envious. Their sense of grandiosity demands superior treatment from all others. They have an arrogant demeanor, lack of empathy and a persistent victim stance. They blame others for everything and exhibit an enormous hypersensitivity. Constructive criticism to narcissists must be very carefully presented because they tend to interpret any suggestion however small as humiliating, degrading, or shameful and can counterattack. If their agenda is curtailed or criticized in any way, narcissists can become hateful, revengeful, and dangerous—sometimes even moving toward an Antisocial Personality Disorder.

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M-5 Cluster B Disorders

Cluster B disorders in the DSM-5 include Narcissistic, Antisocial, Borderline, and Histronic personality disorders. In order to be diagnosed with one of these, the individual must exhibit at least two of four typical defining characteristics in thoughts, feelings, interpersonal relationships, and impulse control. Their patterns of behavior are pervasive, inflexible, deviate markedly from cultural norms and expectations, are stable over time, and lead to distress or impairment. Those with one of these diagnoses struggle with distorted thinking patterns, problematic emotional responses, over- or under-regulated impulse control, and interpersonal difficulties. They find it difficult to regulate their emotions, tend to exhibit overly emotional or unpredictable thinking or interactions with others. Their behaviors are often considered threatening or disturbing. These personality disorders may share some atypical brain features, some of which affect the amygdalae, two tiny brain organs that are involved in regulating emotion and alerting to potential danger. More tomorrow.

Narcissistic vs Antisocial

I keep hearing so much about Narcissism these days and it is scary—in political as well as social-climbing arenas. Are narcissists similar to sociopaths and psychopaths? 

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Edition 5) lists Narcissistic personality disorders separately from Antisocial personality disorders. The non-clinical terms of sociopath or psychopath may be used to describe characteristics of individuals with an Antisocial personality disorder. All are part of the Cluster B disorders that also include Borderline personality disorders and Histronic personality disorders. You could think of it this way: all individuals with an antisocial personality disorder are narcissistic, but not all individuals with a narcissistic personality disorder are antisocial (sociopath or psychopath). More tomorrow. 

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